Comparison of initial limb salvage in 98 consecutive patients with either reversed autogenous or in situ vein bypass graft procedures

Hurley, Joseph J.; Auer, Arthur I.; Binnington, H. Bradley; Hershey, Falls B.; Swensson, Erik E.; Woods, J. J.; Nunnelee, Janice D.

doi:10.1016/0002-9610(85)90428-3

Cited by 21 publications

(4 citation statements)

References 6 publications

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“…13 Additionally, in a study of 97 patients undergoing infrainguinal bypasses for CLTI, the two techniques had similar rates of cumulative patency and limb salvage at 18 months. 14 These findings echo the results of our study. In addition, we observed a decreased risk of reinterventions in patients with CLTI undergoing in-situ bypasses after adjusting for baseline differences.…”

Section: Discussionsupporting

confidence: 89%

“…2 The outcomes associated with the various saphenous vein configurations, such as in-situ, reversed, and nonreversed, transposed bypasses, have been studied but remain controversial. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] The in-situ bypass takes a nonreversed configuration, allowing gradual tapering of vein caliber from proximal to distal. This optimizes size match of proximal and distal anastomoses and provides favorable circulatory dynamics and compliance characteristics.…”

Section: Introductionmentioning

confidence: 99%

“…Existing studies comparing the outcomes of in-situ and reversed GSV are not contemporary and largely limited by small sample size. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] The aim of this study was to examine differences in bypass patency and rate of reintervention in patients undergoing LEBs using in-situ and reversed GSV.…”

Section: Introductionmentioning

confidence: 99%

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Comparative analysis of patients undergoing lower extremity bypass using in-situ and reversed great saphenous vein graft techniques

et al. 2022

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Objective Autologous great saphenous vein (GSV) is considered the conduit of choice for lower extremity bypass (LEB). However, the optimal configuration remains the source of debate. We compared outcomes of patients undergoing LEB using in-situ and reversed techniques. Methods The Vascular Quality Initiative database was queried for patients undergoing LEB with a single-segment GSV in in-situ (ISGSV) and reversed (RGSV) configurations for symptomatic occlusive disease from 2003 to 2021. Patient demographics, procedural detail, and in-hospital and follow-up outcomes were collected. The primary outcome measures included primary patency at discharge or 30 days and one year. Secondary outcomes were secondary patency, and reinterventions at discharge or 30 days and one year. Cox proportional hazards models were created to determine the association between bypass techniques and outcomes of interest. Results Of 8234 patients undergoing LEBs, in-situ and reversed techniques were used in 3546 and 4688 patients, respectively. The indication for LEBs was similar between the two cohorts. ISGSV was performed more frequently from the common femoral artery and to more distal targets. RGSV bypass was associated with higher intraoperative blood loss and longer operative time. Perioperatively, ISGSV cohort had higher rates of reinterventions (13.2 vs 11.1%; p = 0.004), surgical site infection (4.2 vs 3%; p = 0.003), and lower primary patency (93.5 vs 95%; p = 0.004) but a comparable rate of secondary patency (99 vs 99.1%; p = 0.675). At 1 year, in-situ bypasses had a lower rate of reinterventions (19.4% vs 21.6%; p=0.02), with similar rates of primary (82.6 vs 81.8%; p = 0.237) and secondary patency (88.7 vs 88.9%; p = 0.625). After adjusting for significant baseline differences and potential confounders, in-situ bypass was independently associated with decreased risks of primary patency loss (HR 0.9; 95% CI, 0.82–0.98; p = 0.016) and reinterventions (HR 0.88; 95% CI, 0.8–0.97; p = 0.014) but a similar risk of secondary patency loss (HR 0.99; 95% CI, 0.86–1.16; p = 0.985) at follow-up, compared to reversed bypass. A subgroup analysis of bypasses to crural targets showed that in-situ and reversed bypasses had similar rates of primary patency loss and reinterventions at 1 year. Among patients with chronic limb-threatening ischemia, in-situ bypass was associated with a decreased risk of reinterventions but similar rates of primary and secondary patency and major amputations at 1 year. Conclusions In patients undergoing LEBs using the GSV, in-situ configuration was associated with more perioperative reinterventions and lower primary patency rate. However, this was offset by decreased risks of loss of primary patency and reinterventions at 1 year. A thorough intraoperative graft assessment with adjunctive imaging may be performed to detect abnormalities in patients undergoing in-situ bypasses to prevent early failures. Furthermore, closer surveillance of reversed bypass grafts is warranted given the higher rates of reinterventions.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comparative analysis of patients undergoing lower extremity bypass using in-situ and reversed great saphenous vein graft techniques

et al. 2022

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“…Conversely, progressive IH results in graft stenosis, 4,5 which is commonly localized and segmental; the most common site of progressive IH is in a venous valve, and progressive IH occurs in ϳ15% of vein grafts after implantation. 6,7 Furthermore, according to the Project of Ex-Vivo vein graft Engineering via Transfection III (PREVENT III) trial data that were more contemporary and highly vetted, the occurrence of nontechnical graft failure resulting in graft revision or major amputation within 12 months of enrollment is 25.5%. 8 Although many factors, including inflammation, endothelial dysfunction, and alterations in remodeling and matrix deposition contribute to the mechanisms of IH, we believe that the most important factors leading to IH of a vein graft are changes in the phenotype of the tunica media smooth muscle cells in the endothelial denudation area and their migration and proliferation.…”

mentioning

confidence: 99%